腹腔镜开窗取胚术结合甲氨蝶呤局部注射治疗异位妊娠

Embryo extraction by laparoscopic window combined with local injection of methotrexate for treating ectopic pregnancy

目的:探讨甲氨蝶呤局部注射治疗异位妊娠行腹腔镜开窗取胚术效果。方法:选择2018年2月—2020年2月本院收治的异位妊娠行腹腔镜开窗取胚术患者200例分两组各100例。对照组给予常规术后口服米非司酮治疗,观察组在此基础上局部注射甲氨蝶呤,比较两组输卵管再通率、住院时间、再次妊娠情况以及人绒毛膜促性腺激素(β-hCG)水平变化。结果:治疗1周后观察组血清β-hCG水平(78.15±32.28 U/L)低于对照组,β-hCG降至正常时间(8.9±2.4d)及住院时间(5.2±1.4d)均低于对照组,术后3个月输卵管完全畅通、部分畅通、不畅通占比(73.0%、20.0%、7.0%)优于对照组(48.0%、28.0%、24.0%),正常分娩和宫内妊娠(55例,55.0%)优于对照组(38例,38.0%)(均P<0.05)。结论:腹腔镜开窗取胚术结合甲氨蝶呤局部注射能够缩短患者住院时间以及血清β-hCG降低至正常水平时间,利于提高输卵管通液效果,促进患者正常妊娠。

Objective:To explore the therapeutic effect of local injection of methotrexate combined with embryo extraction by laparoscopic window or treating ectopic pregnancy.Methods:200 patients with ectopic pregnancy who underwent embryo extraction by laparoscopic window were selected as observation objects and were divided into two groups according to different treatment plans,(100 cases in each group)from February 2018 to February 2020.After embryo extraction by laparoscopic window,the patients in the control group were given routine postoperative oral mifepristone treatment and the patients in the observation were given methotrexate injected locally.The tubal repatency rate,the time of hospital stay,the repregnant situation,and the change of human chorionic gonadotropin(β-HCG)levels of the patients were compared between the two groups.Results:The level of serumβ-HCG(78.15±32.28 U/L)of the patients in the observation group 1 week after treatment was significant lower than that of the patients in the control group,and the time ofβ-HCG level return to normal(8.9±2.4d)and hospital stay(5.2±1.4d)of the patients in the observation group were significant lower than those of the patients in the control group.The proportions of completely unblocked oviduct(73.0%),partially unblocked oviduct(20.0%),and unblocked oviduct(7.0%)of the patients in the observation group 3 months after operation were significant better than those(48.0%,28.0%,and 24.0%)of the patients in the control group.The normal delivery after intrauterine pregnancy(55 cases,55.0%)of the patients in the observation group was significant better than that(38 cases,38.0%)of the patients in the control group(all P<0.05).Conclusion:Embryo extraction by laparoscopic window and local injection of methotrexate for treating ectopic pregnancy of the women can shorten the hospitalization time of patients and the time of serumβ-HCG level reducing to normal,which is helpful to increase the effect of fallopian tube fluid,and can promote the normal pregnancy and delivery of the women.